Healthcare Provider Details

I. General information

NPI: 1043146178
Provider Name (Legal Business Name): JASMINE NAKIDA GILLISON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15941 DONALD CURTIS DR
WOODBRIDGE VA
22191-4292
US

IV. Provider business mailing address

4796 DANE RIDGE CIR
WOODBRIDGE VA
22193-6519
US

V. Phone/Fax

Practice location:
  • Phone: 703-577-9679
  • Fax:
Mailing address:
  • Phone: 703-577-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016180
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: